Medicare Advantage and Prescription Drug Plans December 28 ...

Plan Communications User Guide Appendices, Version 6.3
F.12 Part C Risk Adjustment Model Output Data File
This is the data file version of the Part C Risk Adjustment Model Output Report, which shows the
Hierarchical Condition Codes (HCCs) used by the RAS to calculate Part C risk adjustment factors
for each Beneficiary. RAS produces the report, and MARx forwards it to Plans as part of the
month-end processing.
The following records are included in this file:
Header Record
Detail Record
Trailer Record
F.12.1 Header Record
Item Field Size Position Comment Description
1 Record Type Code 1 1 Set to "1"
1 = Header
A = Details for old V12 PTC MOR
B = Details for new V21 PTC MOR
3 = Trailer
2 Contract Number 5 2-6 Unique identification for a Medicare
Advantage Contract
3 Run Date 8 7-14 Format as
yyyymmdd
The run date when this file was
created
4 Payment Year and
Month
6 15-20 Format as
yyyymm
This identifies the risk adjustment
payment year and month for the
model run.
5 Filler 180 21-200 Spaces Filler
Total Length = 200
F.12.2 Detail Record Type A
Item Field Size Position Comment Description
1 Record Type
Code
2 Health Insurance
Claim Account
Number
1 1 Set to "A" 1 = Header
A = Details for old V12 PTC
MOR
B = Details for new V21 PTC
MOR
3 = Trailer
12 2-13 Also known as HICAN The HICAN identifies the
primary Medicare Beneficiary
under the SSA or RRB programs.
The HICAN, consisting of
Beneficiary Claim Number
(BENE_CAN_NUM) along with
the Beneficiary Identification
Code (BIC_CD), uniquely
identifies a Medicare Beneficiary.
For the RRB program, the claim
December 28, 2012 F-52 Part C Risk Adjustment Model Output
Data File